Prognostic model based on magnetic resonance imaging, whole-tumour apparent diffusion coefficient values and HPV genotyping for stage IB-IV cervical cancer patients following chemoradiotherapy

• Published in: European radiology Vol. 29; no. 2; pp. 556 - 565
• Main Authors: Lin, Gigin, Yang, Lan-Yan, Lin, Yu-Chun, Huang, Yu-Ting, Liu, Feng-Yuan, Wang, Chun-Chieh, Lu, Hsin-Ying, Chiang, Hsin-Ju, Chen, Yu-Ruei, Wu, Ren-Chin, Ng, Koon-Kwan, Hong, Ji-Hong, Yen, Tzu-Chen, Lai, Chyong-Huey
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2019; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers; Cancer; Cervical cancer; Cervix; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Datasets; Diagnostic Radiology; Diffusion; Diffusion coefficient; Diffusion Magnetic Resonance Imaging - methods; Female; Genotype; Genotyping; Genotyping Techniques - methods; Health risk assessment; Histograms; Histology; Human papillomavirus; Humans; Image Interpretation, Computer-Assisted - methods; Imaging; Internal Medicine; Interventional Radiology; Kaplan-Meier Estimate; Magnetic resonance imaging; Mathematical models; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Neuroradiology; Obstetrics; Oncology; Papillomaviridae - classification; Papillomaviridae - genetics; Parameters; Patients; Predictions; Prognosis; Radiation therapy; Radiology; Regression analysis; Resonance; Retrospective Studies; Risk groups; Survival; Training; Tumors; Ultrasound; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy; Uterine Cervical Neoplasms - virology; Young Adult; Human papillomavirus; Prognosis; Diffusion magnetic resonance imaging; Chemoradiotherapy; Cervical cancer
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-018-5651-4

Objectives To develop and validate a prognostic model of integrating whole-tumour apparent diffusion coefficient (ADC) from pretreatment diffusion-weighted (DW) magnetic resonance (MR) imaging with human papillomavirus (HPV) genotyping in predicting the overall survival (OS) and disease-free survival (DFS) for women with stage IB–IV cervical cancer following concurrent chemoradiotherapy (CCRT). Methods We retrospectively analysed three prospectively collected cohorts comprising 300 patients with stage IB–IV cervical cancer treated with CCRT in 2007–2014 and filtered 134 female patients who underwent MR imaging at 3.0 T for final analysis (age, 24–92 years; median, 54 years). Univariate and multivariate Cox regression analyses were used to evaluate the whole-tumour ADC histogram parameters, HPV genotyping and relevant clinical variables in predicting OS and DFS. The dataset was randomly split into training ( n = 88) and testing ( n = 46) datasets for construction and independent bootstrap validation of the models. Results The median follow-up time for surviving patients was 69 months (range, 9–126 months). Non-squamous cell type, ADC 10 <0.77 × 10 -3 mm 2 /s, T3-4, M1 stage and high-risk HPV status were selected to generate a model, in which the OS and DFS for the low, intermediate and high-risk groups were significantly stratified ( p < 0.0001). The prognostic model improved the prediction significantly compared with the International Federation of Gynaecology and Obstetrics (FIGO) stage for both the training and independent testing datasets ( p < 0.0001). Conclusions The prognostic model based on integrated clinical and imaging data could be a useful clinical biomarker to predict OS and DFS in patients with stage IB–IV cervical cancer treated with CCRT. Key points • ADC 10 is the best prognostic factor among ADC parameters in cervical cancer treated with CCRT • A novel prognostic model was built based on histology, ADC 10 , T and M stage and HPV status • The prognostic model outperforms FIGO stage in the survival prediction